阿司匹林治疗冠心病患者合并上消化道出血的影响因素

Factors associated with upper gastrointestinal bleeding in elderly coronary heart disease patients treated with aspirin

目的研究老年冠心病患者合并上消化出血应用阿司匹林治疗的影响因素分析.方法选取2015-11/2016-11在湖北省汉川市人民医院采用阿司匹林口服治疗的老年冠心病患者纳入214例进行回顾性分析,对发生上消化道出血51例患者的年龄、性别、服药时间、剂量、消化道病史、胃黏膜保护剂使用情况和吸烟史等进行分析.结果患者年龄随着时间逐渐增长,上消化道出血发生率明显增高(χ~2=11.526,P<0.01);服药时间低于3 mo的患者上消化道出血率显著低于服药超过3 mo的患者,差异具有统计学意义(χ~2=8.530,P<0.01);小剂量组患者上消化道出血率明显低于大剂量组,差异具有统计学意义(χ~2=5.127,P<0.01);上消化道出血与患者年龄无相关性(P>0.05),老年冠心病患者有消化道病史或吸烟史的服用阿司匹林肠溶片容易造成上消化道出血(P<0.05),阿司匹林联合胃黏膜保护剂同时服用可有效降低上消化道出血发生率(P<0.05).结论阿司匹林肠溶片联合胃黏膜保护剂,可降低上消化道出血发生率.

AIM To identify the factors associated with upper gastrointestinal bleeding in elderly coronary heart disease patients treated with aspirin.METHODS A total of 214 elderly patients with coronary heart disease who were treated with aspirin from November 2015 to November 2016 at our hospital were retrospectively analyzed, including 51 patients with upper gastrointestinal bleeding. The possible associations of patient＇s age, gender, duration of medication, dosage, usage of gastric mucosa protective agents, and history of smoking with upper gastrointestinal bleeding were analyzed statistically.RESULTS The incidence of upper gastrointestinal hemorrhage increased significantly with age（χ~2 = 11.526, P〈0.01）. The rate of upper gastrointestinal bleeding was significantly higher in patients who took aspirin for 3 mo than in those who took aspirin for 3 mo（χ~2 = 8.530, P〈0.01）, and in patients who received high dose aspirin than in those who received low dose aspirin（χ~2 = 5.127, P〈0.01）. Upper gastrointestinal bleeding had no correlation with gender（P〈0.05）. In patients who took aspirin enteric-coated tablets, the incidence of upper gastrointestinal hemorrhage was significantly higher in patients with a history of gastrointestinal disease or smoking than in those without（P〈0.05）. The use of gastric mucosal protective agents can effectively reduce the rate of upper gastrointestinal bleeding（P〈0.05）.CONCLUSION Aspirin enteric-coated tablets combined with gastric mucosal protective agents can reduce the incidence of upper gastrointestinal bleeding in elderly patients with coronary heart disease.